title: Inspiratory muscle training improves antireflux barrier in GERD patients.
abstract: The crural diaphragm (CD) is an essential component of the esophagogastric junction (EGJ), and inspiratory exercises may modify its function. This study's goal is to verify if inspiratory muscle training (IMT) improves EGJ motility and gastroesophageal reflux (GER). Twelve GER disease [GERD; 7 males, 20-47 yr, 9 esophagitis, and 3 nonerosive reflex disease (NERD)] and 7 healthy volunteers (3 males, 20-41 yr) performed esophageal pH monitoring, manometry, and heart rate variability (HRV) studies. A 6-cm sleeve catheter measured average EGJ pressure during resting, peak inspiratory EGJ pressures during sinus arrhythmia maneuver (SAM) and inhalations under 17-, 35-, and 70-cmH2O loads (TH maneuvers), and along 1 h after a meal. GERD patients entered a 5-days-a-week IMT program. One author scored heartburn and regurgitation before and after IMT. IMT increased average EGJ pressure (19.7 ± 2.4 vs. 29.5 ± 2.1 mmHg; P < 0.001) and inspiratory EGJ pressure during SAM (89.6 ± 7.6 vs. 125.6 ± 13.3 mmHg; P = 0.001) and during TH maneuvers. The EGJ-pressure gain across 35- and 70-cmH2O loads was lower for GERD volunteers. The number and cumulative duration of the transient lower esophageal sphincter relaxations decreased after IMT. Proximal progression of GER decreased after IMT but not the distal acid exposure. Low-frequency power increased after IMT and the higher its increment the lower the increment of supine acid exposure. IMT decreased heartburn and regurgitation scores. In conclusion, IMT improved EGJ pressure, reduced GER proximal progression, and reduced GERD symptoms. Some GERD patients have a CD failure, and IMT may prove beneficial as a GERD add-on treatment.
authors.affiliation: Dept. of Clinical Medicine, Federal Univ. of Ceará, Rua Prof. Costa Mendes 1608-4 andar CEP: 60430-040, Fortaleza, Ceará, Brazil. mans@ufc.br.
authors.forename: Miguel Ângelo
authors.initials: MÂ
authors.lastname: Nobre e Souza
authors.forename: Maria Josire Vitorino
authors.initials: MJ
authors.lastname: Lima
authors.forename: Giovanni Bezerra
authors.initials: GB
authors.lastname: Martins
authors.forename: Rivianny Arrais
authors.initials: RA
authors.lastname: Nobre
authors.forename: Marcellus Henrique Loiola Ponte
authors.initials: MH
authors.lastname: Souza
authors.forename: Ricardo Brandt
authors.initials: RB
authors.lastname: de Oliveira
authors.forename: Armênio Aguiar
authors.initials: AA
authors.lastname: dos Santos
mesh_terms: D000328:Adult; D004947:Esophagus / Q000503:physiopathology*; D005260:Female; D005764:Gastroesophageal Reflux / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D055070:Resistance Training; D012132:Respiratory Muscles / Q000503:physiopathology*
keywords: GERD; crural diaphragm; lower esophageal sphincter; muscle training